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January 1976

Tricuspid Regurgitation Following Inferior Myocardial Infarction

Author Affiliations

From the Division of Cardiology, University of Kentucky Medical Center, Lexington, Ky (Dr McAllister), and the Division of Cardiology, Vanderbilt University Hospital, Nashville, Tenn (Drs Friesinger and Sinclair-Smith).

Arch Intern Med. 1976;136(1):95-99. doi:10.1001/archinte.1976.03630010075015

Isolated tricuspid incompetence is uncommon and is usually tolerated well.1-3 It has been reported after trauma,1-4 with papillary muscle rupture after myocardial infarction,5 after bacterial endocarditis,6,7 after rheumatic fever,8 and as a congenital anomaly.9 In addition, incompetence of the valve after dilatation of the annulus may result from pulmonary hypertension and subsequent severe right ventricular failure.10 In this report, we present two patients with tricuspid insufficiency occurring after inferior wall myocardial infarction and possibly caused by right ventricular papillary muscle dysfunction, a syndrome not previously recognized.11


Patient 1.—  A 68-year-old retired farmer was admitted to Vanderbilt University Hospital because of persistent ascites. He had been well until four years earlier, when he suffered an inferior wall myocardial infarction. Two years after an uneventful recovery, he noted abdominal swelling; this subsequently proved refractory to outpatient therapy with digitalis, sodium restriction, and

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